Healthcare Heroes Prize Giveaway
Complete this form to recognize a healthcare hero on Hawai`i Island!  All healthcare heroes nominated through this form will be entered to win prizes during the 2021 Healthcare Hero Mahalo Concert.  

The concert is FREE and will be broadcasted LIVE on Saturday, November 6th from 6:00-9:00pm HST on Nā Leo TV Channel 54 or on Facebook LIVE!  Tune in to the concert to see if your healthcare hero is a lucky winner!

Submissions are due by October 22, 2021
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Nominator Name (if you would like to remain anonymous, please leave this blank)
Name of Healthcare Hero *
Nominee's residing district *
Healthcare hero phone number or email address (this information will only be used if your healthcare hero is a lucky winner) *
In three or less sentences, please describe why you feel this person is a healthcare hero. (ex:  "Person A" is a healthcare hero because she/he/they spend numerous hours a week assisting with COVID testing and vaccinations.) *
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